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There are many causes of tremors and other symptoms associated with Parkinson's disease and it may take time to make an accurate diagnosis. A neurologist who specializes in movement disorders is the best person to make or confirm a diagnosis. The following information describes other disorders (Parkinsonism) that may be confused with Parkinson's. The following conditions are rare, and can be found on the website of the National Organization for Rare Disorders. 

See Rare Diseases.

Progressive Supranuclear Palsy (PSP)

Early development of balance problems, frequent falls, rigidity or stiffness of the trunk of the body, and (eventually) eye-movement problems can be symptoms of PSP. Symptoms usually begin after age 50 and progress more rapidly than those associated with Parkinson's disease. The most characteristic eye movement abnormality is called vertical gaze paralysis, making looking up and looking down very difficult. People with PSP may experience frequent falls while walking down stairs because they cannot look down. Dementia, depression and alterations in mood may develop later in the disease. Speech therapy, physical therapy, and antidepressants may alleviate symptoms and while there is no specific treatment for PSP, some Parkinson's medications may provide some symptom relief.

See the Society for Progressive Supranuclear Palsy.

Corticobasal Degeneration (CBD)

The least common cause of symptoms similar to Parkinson's is CBD. It often affects one side far more than the other and it may progress more rapidly than Parkinson's disease. The initial symptoms of CBD usually develop after age 60 and include asymmetric bradykinesia (uncontrolled movement focusing on one side or the other), rigidity, limb dystonia (abnormal, prolonged, and repetitive muscle contractions that may cause twisting or jerking), balance problems, and speech/language problems. There is often marked and disabling apraxia (the loss of ability to carry out an intended movement even though there is no weakness or sensory loss in the arm or leg). There is no specific treatment for CBD. Supportive treatment such as botulinum toxin for dystonia, antidepressant medications and speech and physical therapy may help. Levodopa and dopamine, seldom offer benefit.

Multiple System Atrophy (MSA)

MSA is a neurodegenerative disease of unknown cause. Initially it may be difficult to distinguish from Parkinson's disease, but it is far less common and progresses more rapidly. The average age of onset is in the mid-50s. Symptoms include one or a combination of the following: bradykinesia, poor balance, abnormal autonomic function, rigidity, or difficulty with coordination. Abnormalities of autonomic function include impotence, low blood pressure upon standing (orthostatic hypotension), excessive or reduced sweating, and constipation.

There are three different subtypes of MSA:

  • Striatonigral degeneration (SND) is characterized by Parkinson's symptoms but without much tremor and with poor response to Sinemet.
  • Shy-Drager syndrome is characterized by Parkinson's symptoms and autonomic abnormalities.
  • Olivopontocerebellar atrophy (OPCA) may involve a lack of coordination and clumsiness which affect balance and gait.

See the Multiple System Atrophy Coalition.

Dementia with Lewy Bodies (DLB)

This disorder is characterized by early dementia, prominent hallucinations, changes in cognitive functioning throughout the day, and symptoms similar to Parkinson's disease. Other symptoms include difficulties with attention, problem solving, planning, and with recognizing figures and images.

See Lewy Body Dementia Association.

Here are other resources that individuals diagnosed with either PSP, CBD or MSA can access:

Parkinson Society British Columbia (PSBC) aims to offer support to all those affected by Parkinson’s disease, which extends to Parkinson’s Plus Syndromes. Although we may not have all the answers, we have heard many of the questions and will help find more information.

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